[jellybean]

I am sorry to hear your wife's story. First, Herceptin for me has virtually no side effects, and I have been on it for 3 and a half years. (I have metastatic disease.) I don't know enough about the heart to know what a mitral valve prolapse is. I think that the way that Herceptin causes heart failure is that it decreases the left ejection fraction, the amount of blood pumped by the left side of the heart. Typically, women are given a echocardiogram or Muga scan prior to Herceptin treatment and periodically during Herceptin treatment to make sure their heart is pumping OK. If it is not, one might be taken off of Herceptin to give the heart time to recover. Typically, any heart problems caused by Herceptin are reversible.

Chemo, particularly the TCH regimen often given for Her2 positive breast cancer, is very doable for many. I ran, biked, and worked part time while on chemo.

Actually, the Her2 positive ER positive pathology is a good one, since your wife will have the benefit (hopefully) of both Herceptin and anti-hormonal therapy. The good news is that she is node negative and the tumor is extremely small. (In fact, until very recently chemo and Herceptin was not recommended for women with tumors less than 1 cm.) If Herceptin is not a possibility, perhaps she could have Tykerb, another targeted treatment for Her2 positive disease. The positive margins would be resolved by a mastectomy, so that won't have a negative effect on her.